Center's electronic process increases satisfaction
Retail pharmacy data included in process
Some hospital pharmacists are finding that the best medication reconciliation process involves electronic data and access.
"We've developed a process where we electronically record all of these data into a grid, and the information then is placed on a report," says Brian D. Latham, PharmD, a pharmacy operations manager for St. Rita's Medical Center of Lima, OH.
Physicians can check the electronic report to see whether they'd like to continue the patient's medication, hold it, or have a dosage or other change on admission, Latham says.
The electronic system has created a much safer transfer process, and makes data easier to read in the pharmacy. Also, nursing, pharmacy, physician, and patient satisfaction with medication reconciliation has improved since implementation of the electronic form.1
Physicians were involved in developing the new process, and so their overall satisfaction with the medication reconciliation process is good, Latham notes.
"We did chart reviews earlier this year, and 95% or more of every patient has had an initial medication reconciliation done within the first 24 hours," Latham says.
For nurses, the new process means that less responsibility is placed on their shoulders for medication changes and re-continuations, he adds.
Since the electronic process was implemented, there have been fewer medication error reports involving communication breakdowns in the hospital.1
"We went through a lot of revisions of these forms, and I think we have a good process," Latham says. "It was new to physicians, but it's definitely improved patient safety in the process."
The electronic system includes an electronic report that details prescription information from retail pharmacies about a patient admitted to the hospital, Latham says.
Such information isn't available for 40% of patients, but when it is available it provides baseline data that are particularly useful when patients enter the hospital in an altered mental state or when they don't know what their drugs are, Latham says.
"So right after admission, the medication information goes into a separate computer system, and within five to 10 minutes a report prints out on each nursing unit printer for all patients," Latham explains. "They can take that into the room when they do an assessment."
The retail pharmacy information is available only to medical providers, he notes.
Once the baseline interview is completed and the physician has reviewed and approved it, the information is placed in the chart.
"We don't have physician order entry, so doctors check off manually the home medications they'd like to continue," Latham says. "If they'd like to add any new meds they can do that as well."
The nurse goes through the interview, with a computer that is available at bedside or on a rolling cart, and places all patient information into the computer system. After she's completed the patient interview, she generates a report and prompts it to print, Latham explains.
The hard copy is placed in the chart for the physician to review.
For the minority of cases where the nurse has to rely on the patient interview or family interview to obtain medication information, she might call the patient's pharmacy to fill in missing data, Latham says.
"Occasionally, decentralized pharmacists are called if nurses can't identify a medication that we can identify through our system," he adds. "Typically, the pharmacists don't do that initial interview."
When patients are transferred to another level of care, such as rehabilitation or a psychiatric unit, a new form is developed and printed out.
It includes all of the patient's current medications, and the physician reviews these with another check-box process, Latham says.
"We make sure in every transfer process that the whole list of medications is signed on again," he says.
The same process continues when patients have surgery. This check-box report makes it convenient for surgeons and other health care providers to quickly view all of the medications a patient has taken prior to surgery, he adds.
At discharge, the original sheet with the home medications is compared with the current inpatient list of medications.
"So a final list before discharge needs to be developed for the patient, comparing the original list and the new list to see what needs to be continued," Latham says. " The nurse takes the information of what the physician selects for the discharge list and places the changes into the computer system.
"Patients see a list that says, 'These are your home medications; these are the medications that were changed while you were in the hospital, and here are the medications you should stop taking,'" Latham explains.
"Patients have a nice list when they leave the hospital, and it has all of their home medications," he adds. "They can take that list to the next provider for a follow-up appointment."
One of the challenges the hospital faced when launching the new electronic medication reconciliation process was obtaining physician buy-in for the checklist part of the process, Latham notes.
Physicians were accustomed to signing off only on the medications they prescribed for patients and were initially reluctant to take responsibility for the entire list of drugs, he says.
Without having one person in charge, it would be difficult to coordinate the entire list of medications, so one physician had to be named the point person on this.
"The attending physician is ultimately responsible," Latham says. "Although the nurses sometimes have to coordinate with some of the other physicians.
"I went to many physician division meetings, and we had physician champions involved who spoke in support of the forms at meetings," Latham says.
It is all a matter of physicians taking time to do the medication reconciliation at transfer.
"I think we had a good buy-in because we made it an easy process for the physician," he says. "The forms are self-explanatory."
Reference
- Latham BD. Medication reconciliation: from admission to discharge using electronically generated medication forms from a clinical information system. Abstract presented at the 2006 Mid-Year Clinical Meeting of the American Society of Health-System Pharmacists; Anaheim, CA; Dec. 3-7, 2006.
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